Student Information

Name:*
Gender:*
Date of birth:*
Name of Parent/Guardian:*
Contact phone:*
-
Select:*
Home address:*
Languages spoken at home:*
Has your child ever been in a Montessori school before?
Does your child have any special needs? List all needs and current medications taken, if any:

Program Information

Program Choice:*
Program Days:*

Please refer to School brochure for tuition information.

Healthy Kids Meal Plan (Please refer to school brochure for plan details and rates):
Before School Care Program:*
After School Care Program:*

If Yes for Before/After school Program, please fill in the following details about drop off/pick-up times.

School Drop off Time:
School Pick-up Time:

Parent / Guardian Information

Marital Status of Parents:*
Custodial Parent(s):*
Parent/Guardian 1:*
What does your child call Parent/Guardian 1?*
Home Address #1 (if different):
Contact #1 Phone:*
-
Choose:*
Parent/Guardian 2:*
What does your child call Parent/Guardian 2?*
Home Address #2 (if different):
Contact #2 Phone:*
-
Choose:*
Ethnicity (optional):
Please specify:
How did you hear about us?
Please specify:
Word Verification: